TY - JOUR
T1 - The effect of radiation on quality of life throughout the breast reconstruction process
T2 - A prospective, longitudinal pilot study of 200 patients with long-term follow-up
AU - Devulapalli, Chris
AU - Bello, Ricardo J.
AU - Moin, Emily
AU - Alsobrooks, James
AU - Fallas, Pablo Baltodano
AU - Ohkuma, Rika
AU - Manahan, Michele A.
AU - Sacks, Justin M.
AU - Cooney, Carisa M.
AU - Rosson, Gedge D.
N1 - Funding Information:
This project was funded by LifeCell Corp. (Branch-burg, N.J.) as an investigator-initiated research grant. The authors would like to acknowledge Oscar Reyes Gaido’s help in this project with data entry and data management.
Publisher Copyright:
© 2018 by the American Society of Plastic Surgeons.
PY - 2018
Y1 - 2018
N2 - Background: Despite well-established correlation of postmastectomy radiotherapy and surgical complications in breast reconstruction, its impact on patient reported outcomes is less clear. We sought to determine the effect of postmastectomy radiotherapy on patient reported outcomes throughout the breast reconstruction process. Methods: Patients undergoing prosthetic and autologous breast reconstruction from November 2010 to June 2013 were prospectively followed with BREAST-Q surveys (preoperatively, after expander placement, and 6 and 12 months after final reconstruction). Paired t test, Wilcoxon rank sum test, and multiple linear regression were used to determine the effect of radiation on patient reported outcomes. Results: Two hundred patients were included in the study, of which 51 (25.5 percent) received postmastectomy radiotherapy. Prosthetic reconstruction was performed in 75 patients (37.5 percent), autologous reconstruction was performed in 118 (59 percent), and pure fat grafting was performed in seven (3.5 percent). At one-year follow-up, the nonirradiated group reported higher BREAST-Q scores when compared with the irradiated group, in Satisfaction with Breasts (p = 0.003), Psychosocial Well-being (p = 0.003), Sexual Well-being (p < 0.001), Physical Well-being of Chest (p = 0.024), and Satisfaction with Outcome (p = 0.03). When accounting for baseline values, Satisfaction with Breasts and Physical Well-being of Chest significantly worsened in irradiated patients undergoing prosthetic reconstruction, an effect not seen with autologous reconstructions. All irradiated patients significantly worsened in Psychosocial Well-being and Sexual Well-being scores. Conclusions: Postmastectomy radiotherapy is associated with worse patient reported outcomes following breast reconstruction. Autologous reconstruction can mitigate patient dissatisfaction in some domains.
AB - Background: Despite well-established correlation of postmastectomy radiotherapy and surgical complications in breast reconstruction, its impact on patient reported outcomes is less clear. We sought to determine the effect of postmastectomy radiotherapy on patient reported outcomes throughout the breast reconstruction process. Methods: Patients undergoing prosthetic and autologous breast reconstruction from November 2010 to June 2013 were prospectively followed with BREAST-Q surveys (preoperatively, after expander placement, and 6 and 12 months after final reconstruction). Paired t test, Wilcoxon rank sum test, and multiple linear regression were used to determine the effect of radiation on patient reported outcomes. Results: Two hundred patients were included in the study, of which 51 (25.5 percent) received postmastectomy radiotherapy. Prosthetic reconstruction was performed in 75 patients (37.5 percent), autologous reconstruction was performed in 118 (59 percent), and pure fat grafting was performed in seven (3.5 percent). At one-year follow-up, the nonirradiated group reported higher BREAST-Q scores when compared with the irradiated group, in Satisfaction with Breasts (p = 0.003), Psychosocial Well-being (p = 0.003), Sexual Well-being (p < 0.001), Physical Well-being of Chest (p = 0.024), and Satisfaction with Outcome (p = 0.03). When accounting for baseline values, Satisfaction with Breasts and Physical Well-being of Chest significantly worsened in irradiated patients undergoing prosthetic reconstruction, an effect not seen with autologous reconstructions. All irradiated patients significantly worsened in Psychosocial Well-being and Sexual Well-being scores. Conclusions: Postmastectomy radiotherapy is associated with worse patient reported outcomes following breast reconstruction. Autologous reconstruction can mitigate patient dissatisfaction in some domains.
UR - http://www.scopus.com/inward/record.url?scp=85044328315&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85044328315&partnerID=8YFLogxK
U2 - 10.1097/PRS.0000000000004105
DO - 10.1097/PRS.0000000000004105
M3 - Article
C2 - 29481390
AN - SCOPUS:85044328315
SN - 0032-1052
VL - 141
SP - 579
EP - 589
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 3
ER -